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January 11, 1980

Autonomic Neuropathy Complicating Rheumatoid Arthritis

JAMA. 1980;243(2):152. doi:10.1001/jama.1980.03300280050032

Whether associated with peripheral neuropathy, as is usually the case, or not, autonomic neuropathy, particularly that of the cardiovascular system, does not burden the mind with a cumbersome differential diagnosis. In fact, the diagnostic exercise halts after an instant evocation of diabetes. So much has been written recently about diabetic autonomic neuropathy and its effects on the heart and circulation that one tends to overlook other etiologic links.

One such link is with rheumatoid arthritis. Its existence, suspected by Kalliomäki et al1 (1963) and Bennett and Scott2 (1965) on the basis of deficient sweating responses in patients with rheumatoid arthritis and peripheral neuropathy, has been recently confirmed by Edmonds et al.3 These investigators demonstrated autonomic neuropathy by assessing the integrity of cardiovascular reflexes in 68 subjects who were divided into four groups: patients with classic rheumatoid arthritis both seropositive and seronegative, patients with osteoarthritis, an older control